Powering Proactive Care: FHIR Subscriptions as the Foundation for Time-Sensitive Patient-Centered Decision Support - Applicant Address: 55 East Monroe Street, 30th Floor, Chicago, IL 60603 Contact Name, Phone, and Email: Prashila Dullabh; (202) 280-9294; dullabh-prashila@norc.org Website: norc.org NORC at the University of Chicago (NORC) and our partners at Elimu Informatics, Inc. and Emory Healthcare are pleased to submit our proposed project “Powering Proactive Care: FHIR Subscriptions as the Foundation for Time-Sensitive Patient-Centered Decision Support” in response to Special Emphasis Notice Area 1: Demonstrate readiness of FHIR®-based Subscriptions capability as a foundational health IT capability for improved interactivity with third-party applications. Our project proposes to enhance an existing prototype hypertension application by integrating Health Level Seven® (HL7) Fast Healthcare Interoperability Resources® (FHIR)-based Subscriptions and demonstrating Subscription capabilities through two clinically significant real-world use cases: 1) automated identification of patients for timely enrollment into a targeted care program, and 2) real-time follow-up with patients and their clinicians to enable prompt clinical response. We will conduct a pilot study using the enhanced prototype application to assess its feasibility and scalability to demonstrate the readiness of FHIR-based Subscription capability as a foundational to health IT capability for improved interactivity with third-party applications. The proposed enhanced hypertension application will automate identification of potentially eligible patients for enrollment in the remote pregnancy-induced hypertension monitoring program and provide real-time follow-up with patients that report elevated blood pressure. Our project will explore the real-time exchange of clinical data between electronic health records (EHRs) and third-party applications and demonstrate FHIR-based Subscriptions as a foundational capability in remote monitoring. Our proposed approach leverages the strengths of a team of experts in clinical decision support, FHIR standards, health IT implementation and evaluation, project management, stakeholder engagement and healthcare operations who have an extensive history of collaboration on digital health and health IT projects. NORC will serve as the lead institution to provide strategic direction and support overall project implementation, working with partners (Elimu Informatics, Inc. and Emory Healthcare) to design, implement, and evaluate the enhanced prototype hypertension application across six key steps: 1) stakeholder-driven requirements gathering, 2) application design and development, 3) patient-informed testing and refinement, 4) integration, 5) pilot implementation in clinical settings, and 6) evaluation. Throughout the project, we will engage health IT experts as a part of a Technical Expert Panel (TEP) to understand industry needs related to interoperable health IT, assess technical feasibility of the enhanced application, and identify future opportunities for adoption and scaling. Through our proposed project, we aim to demonstrate FHIR-based Subscription capability as foundational health IT by leveraging use cases relevant to other patient populations and clinical scenarios and strengthening potential scalability for other clinical use cases or EHR systems. Our project will result in a report of lessons learned from the pilot and evaluation, a manuscript, and published prototype specifications in GitHub. Together with Elimu Informatics, Inc. and Emory Healthcare, we will contribute to advancing maturity of FHIR-based Subscriptions and expanding API-based digital health care across the United States.
